Preparing for Birth: A Guide to the Pelvic Floor, Biomechanics, and Pushing
Table of Contents
What Happens During Pushing?
The 2 Jobs of the Pelvic Floor
The Biggest Myth About Pushing
Pressure Is Your Secret Weapon
Why Position Matters More Than You Think
More than Kegels
Before Labor
As your due date approaches, it's normal to start thinking about labor and delivery.
These questions may start to feel familiar:
"How do I know if I'm pushing correctly?"
"Should I be doing Kegels?"
"What position should I deliver in?"
"Can I prepare my body for birth?"
We’re here to help you answer these questions. No exercise, stretch, or birth plan can guarantee a specific labor experience, but there are absolutely ways to help your body prepare for the demands of birth.
The goal isn't to create the "perfect birth."
The goal is to understand how your body works so you can move through labor with confidence, adaptability, and a few more tools in your toolbox.
First Things First: What Happens During Pushing?
When people think about labor, they often picture the pushing stage. What many don't realize is that pushing is only one small part of a much larger process.
Before pushing begins, your body has already been doing an incredible amount of work:
The cervix softens and dilates
The uterus creates rhythmic contractions
The baby rotates through the pelvis
The pelvic floor begins to lengthen and adapt
By the time active pushing starts, your baby has already traveled a significant portion of the journey.
Pushing is about working with your body's natural mechanics to help your baby navigate the final part of the birth canal.
Your Pelvic Floor Has Two Jobs During Birth
Most people hear about strengthening the pelvic floor. Most people do not hear about its ability to relax.
The pelvic floor is a group of muscles that sits at the bottom of the pelvis and supports the bladder, uterus, and rectum. Throughout pregnancy, these muscles work hard to provide support and manage increasing pressure.
During birth, however, the pelvic floor has a different job. It must lengthen.
Research has shown that the pelvic floor undergoes significant stretching during vaginal delivery, particularly the levator ani muscle group. In fact, these muscles can lengthen three times beyond their resting state as the baby's head descends through the pelvis.
This is one reason why birth preparation isn't simply about strengthening. A muscle that can contract but cannot relax is not functioning optimally.
The pelvic floor needs both strength and flexibility: think of it less like training for a maximal lift and more like preparing for an athletic event that requires coordination, endurance, mobility, and adaptability.
The Biggest Myth About Pushing
One of the most common misconceptions surrounding labor is that pushing should feel like doing an intense abdominal crunch while holding your breath.
For some individuals and in certain situations, directed breath-holding pushing may be appropriate. But research increasingly supports allowing women to follow their body's natural urge to push whenever possible.
This is often referred to as physiologic or spontaneous pushing.
Rather than forcefully bearing down for long counts of ten, spontaneous pushing allows the body to coordinate breathing, abdominal pressure, uterine contractions, and pelvic floor relaxation more naturally.
The result is often more efficient force production with less unnecessary tension.
We’re pushing smarter, not harder.
Understanding Pressure: Your Secret Weapon
One of the most important concepts in birth preparation is pressure management. Every breath you take creates pressure changes inside your abdomen. Throughout pregnancy, your diaphragm, abdominal muscles, pelvic floor, and spine work together to manage these forces. During labor, that pressure system becomes one of your greatest assets.
When the diaphragm descends and the abdominal wall coordinates effectively, pressure can be directed downward to assist with fetal descent.
This is why breathing strategies often become a major focus in pelvic floor physical therapy. Learning how to work with pressure rather than fight against it can make labor feel more efficient and controlled.
Why Position Matters More Than You Think
Many people picture birth happening flat on a hospital bed. But in reality, the pelvis is designed to move - it is not a rigid structure. The pelvis contains multiple joints that allow subtle changes in shape and dimensions throughout labor.
Different positions can influence:
Baby’s rotation through the pelvis
Maternal comfort
Efficiency of pushing
Pressure distribution
Pelvic outlet space (where the pelvic floor muscle originate)
Pelvic inlet space (where our abdominal muscles attach)
Pressure distribution
Let’s look at some commonly utilized positions.
1. Side-Lying
Helpful for:
Conserving energy
Reducing perineal strain
Slowing a rapid delivery
Individuals with epidurals
2. Hands-and-Knees
Helpful for:
Back labor
Encouraging fetal rotation
Relieving pelvic pressure
Creating more space within the pelvis
3. Supported Squatting
Helpful for:
Increasing pelvic outlet dimensions
Utilizing gravity
Encouraging fetal descent
4. Upright Positions
Helpful for:
Promoting movement
Utilizing gravity
Enhancing comfort and control
There is no single "best" birth position.
The best position is often the one that creates the most space, comfort, and efficiency for both parent and baby at that moment. The benefit of birth preparation through pelvic floor therapy is experimenting with different birthing positions to find which positions work best for your body.
Birth PREP Is More Than Kegels
One of the biggest misconceptions in prenatal fitness is that preparing for birth means doing hundreds of Kegels a day.
The reality is much more nuanced.
Birth preparation may include:
Pelvic floor strengthening
Pelvic floor relaxation training
Breathing mechanics
Hip mobility
Core coordination
Perineal mobility
Labor positioning practice
Pressure management mechanisms
Pain management strategies
For some individuals, the most important skill is learning how to generate force. But for others, it's learning how to let go of unnecessary tension. The answer depends on the person sitting in front of us.
What Can You Do Before Labor?
One of the most empowering things about birth preparation is that it doesn't require perfection. Small, consistent habits can help your body feel more prepared.
Consider:
Walking regularly
Maintaining strength throughout pregnancy
Practicing diaphragmatic breathing
Exploring labor positions
Improving spinal and hip mobility
Learning pelvic floor relaxation techniques
Meeting with a pelvic floor therapist
The goal is not to train your body to perform.
The goal is to help your body adapt.
A Final Thought
Birth is not a test of strength.
It is not a measure of your pain tolerance.
It is not a reflection of how prepared you were.
Birth is a dynamic process involving your baby, your body, your nervous system, and countless factors outside of your control.
Preparing for birth isn't about guaranteeing an outcome.
It's about understanding your options, building confidence in your body, and creating a foundation that allows you to respond to whatever labor brings.
Your pelvic floor doesn't need to be perfect.
Your pushing doesn't need to be perfect.
You don't need to be perfect.
You simply need the knowledge, support, and tools to help your body do what it was designed to do.
Medical Disclaimer:
This blog is intended for educational purposes only and should not be considered medical advice. Every pregnancy, labor, and delivery experience is unique. If you have questions about labor preparation, pelvic floor function, or birth planning, consult your healthcare provider or a qualified pelvic health physical therapist for individualized guidance.
